Provider Demographics
NPI:1235731001
Name:BARNETT, KENNETH ANDRE (DPT)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ANDRE
Last Name:BARNETT
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25241 ELEMENTARY WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7883
Mailing Address - Country:US
Mailing Address - Phone:239-947-4184
Mailing Address - Fax:239-947-4171
Practice Address - Street 1:10676 COLONIAL BLVD STE 50
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8715
Practice Address - Country:US
Practice Address - Phone:239-465-4880
Practice Address - Fax:239-465-4604
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23388225100000X
IL70025190225100000X
FLPT42877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist